OBJECTIVE: This report presents statistics on ambulatory care visits to physician offices, hospital outpatient departments, and hospital emergency departments. Ambulatory medical care utilization is described in terms of patient, practice, facility, and visit characteristics. Office-based care is further subdivided into the categories of primary care, surgical specialties, and medical specialties. METHODS: Data from the 2001 and 2002 National Ambulatory Medical Care Surveys (NAMCS) and National Hospital Ambulatory Medical Care Surveys (NHAMCS) were combined to produce averaged annual estimates of ambulatory medical care utilization. RESULTS: Patients in the United States made an estimated 1.1 billion visits per year in 2001 and 2002 (annual average) to physician offices, hospital outpatient departments, and emergency departments, a rate of 3.8 visits per person annually. This marks the first time that the annual estimate of visits has surpassed the billion mark and is also a significant increase from the 1999-2000 estimate. The change was primarily driven by a jump in the number of visits to primary care physicians. The distribution of visits by patient age, sex, race, expected source of payment, geographic region, and whether the visit occurred in a metropolitan statistical area (MSA) varied across ambulatory care settings. Females had higher visit rates than males to all settings except office-based surgical specialists and emergency departments (ED). Black persons had higher visit rates than white persons to hospital outpatient and emergency departments, but lower visit rates to office-based surgical and medical specialists. Visits to emergency departments were more likely to be patient-paid or no charge, possibly reflecting a lack of private health insurance, than were visits to physician offices. Visit rates to office-based medical specialists were more than double in MSAs compared with non-MSAs.
To describe the integration of the Fundamentals of Care framework into clinical quality development in a large hospital department and explore how it contributed to shared understanding, implications for nursing leadership, and operationalization. The study was a descriptive organizational case study combining top-down policy direction with bottom-up operationalization of a nursing framework in routine clinical settings. The study was conducted in a Danish regional university hospital department encompassing four medical specialties. Methods for integration included a professional governance structure with steering group meetings and inter-ward networks. Data on integration outcomes included the products developed under this governance structure as well as surveys of hospital-wide opinions about framework implementation. Integration outcomes included reflective tools, shared quality improvement themes, use of appreciative inquiry-guided engagement processes, and quarterly improvement cycles that addressed fundamental care topics across diverse clinical contexts. Furthermore, hospital-wide surveys indicated that the framework provided a shared language and values base for quality improvement but required operationalization to achieve clinical relevance. Integration was supported by the professional governance attributes accountability, professional obligation, collateral relationships, and decentralized decision-making. While direct impacts on patient outcomes were difficult to isolate, the Fundamentals of Care framework fostered reflective practice and alignment with core nursing values. Integrating a theoretical framework like Fundamentals of Care into clinical quality development is feasible but requires deliberate translation, leadership support, and organizational structures that prioritize professional autonomy and cross-level collaboration. The Fundamentals of Care framework can serve as catalyst for cultural transformation when integrated through professional governance structures. Local adaptation, reflective tools, and relationship-based approaches support sustainability and clinical anchoring.
To characterise the current clinical adoption of AI-driven automation and adaptive radiotherapy (ART) in Italy. A structured, modular questionnaire was distributed to 133 Italian radiotherapy and medical physics departments. The survey captured: centre characteristics, clinical use of automation tools (synthetic-imaging, autosegmentation, autoplanning, motion management, and QA automation), ART implementation (offline/online approaches, triggers, dose summation, and patient-specific QA) and perceived benefits and barriers. Responses were analysed including the maturity index (MI), defined as a weighted sum of 14 binary implementation items spanning key workflow domains. Sixty-one centres responded (46.0%). Routine autosegmentation was reported by 45/61 centres (73.8%) and autoplanning by 27/61 (44.2%). Only 5 centres reported having performed a dedicated FMEA for automation-related processes; heterogeneous QA approaches were reported by 21/61 (34%). A broad definition of ART (including offline re-planning prompted by interfractional changes) was reported by 56/61 centres (91.8%); however, online inter-fraction and intra-fraction adaptation remained limited and largely confined to centres with dedicated ART-ready platforms. Mean (median) MI was 4.99 (5.00) on a theoretical maximum of 9.334, with a weak positive correlation with the number of installed LINACs (r = 0.25, p = 0.049). Among responding centres, automation tools are widely available and ART is frequently practised, predominantly through offline approaches. The results suggest that broad penetration of adaptive practices does not yet correspond to homogeneous end-to-end maturity. Standardisation of QA, clearer operational definitions of ART triggers, formal risk analysis, and validated dose accumulation workflows appear as key priorities to support broader and safer scaling of online adaptive strategies.
Candida species are opportunistic pathogens that can cause life-threatening infections, especially in immunocompromised patients. Azole antifungals are widely used for treatment, but resistance is increasing and often due to mutations in the ERG11 gene that compromises their efficacy. This study aimed to determine the prevalence of azole-resistant Candida spp. among immunocompromised patients and identify mutations in the ERG11 gene associated with resistance. In this cross-sectional study, clinical samples were processed from immunocompromised patients at two University Hospitals in Egypt. Identification of Candida spp. was done using culture on Sabouraud's Dextrose agar as well as Candida Differential agar supplemented by automated identification by the mass spectrometry method (MALDI-TOF, Vitek MS, bioMérieux, France). Susceptibility to fluconazole and voriconazole was assessed using broth microdilution method. Resistant isolates were subjected to PCR amplification and Sanger sequencing of ERG11 hot spot regions. Out of 1404 eligible samples, 90 (6.4%) yielded Candida spp., predominantly C. tropicalis (44.4%) and C. albicans (41.1%). Resistance to fluconazole and voriconazole was observed in 14.4% and 13.3% of isolates, respectively. ERG11 sequencing revealed multiple mutations. Common missense mutations included Y132F (50%) and S154F (33.3%). A novel mutation (M306R) was identified in two C. tropicalis isolates. Azole resistance among Candida isolates is notable in immunocompromised patients. The present study highlights both known and novel ERG11 mutations, emphasizing the need for routine molecular surveillance to guide antifungal therapy.
Herpes simplex keratitis (HSK) is an ocular viral infectious disease with limited therapeutic options and increasing resistance, leading cause of infectious blindness worldwide. Bufalin is a cardiotonic steroid, more specifically a bufadienolide, which can be found in many plant or animal species, but their main sources are skin and parotid gland secretions of toads (such as Bufo bufo gargarizans Cantor), which constitutes the traditional Chinese medicine preparation known as Chan Su (Venenum Bufonis). Despite its broad pharmacological activities, the potential role of bufalin in controlling HSK progression remains to be systematically investigated. This study systematically evaluates the antiviral and anti-inflammatory activities of commercial bufalin standards along with the underlying mechanisms in an HSK mouse model, aiming to discover lead compounds for the treatment of drug-resistant HSK. In vivo studies were conducted using an HSK mouse model established via corneal infection with either HSV-1F or the clinically acyclovir (ACV)-resistant strain HSV-1/153. In vitro experiments were conducted in ARPE-19 and HCEC cell lines, commonly used in ophthalmic research. Plaque assay, RT-qPCR, Western blot, CCK-8, sodium fluorescein staining, H&E staining, and other related experiments were employed to evaluate the antiviral and anti-inflammatory activities of bufalin. The ocular and systemic toxicities of topical bufalin were evaluated using in vivo confocal microscopy, TUNEL staining, body weight monitoring, and organ index analysis. Bufalin and Chan Su alleviates corneal damage in HSK mice, due to its antiviral and anti‑inflammatory activities both in vitro and in vivo. Bufalin not only inhibits the replication of viruses including HSV-1F and HSV-1/153 strains but also reduces inflammatory infiltration and the expression of inflammatory cytokines (IL-1β and IL-6) in the corneas of HSK mice. RNA-seq analysis reveals that bufalin may act as a potential broad-spectrum antiviral agent by upregulating OAS1 and ISG15 expression, which may represent a distinct antiviral mechanism distinct from ACV. No systemic or ocular toxicity was observed with bufalin at therapeutic doses in this study. These findings identify the natural product bufalin as a potential candidate against drug-resistant HSK by modulating the expression of broad-spectrum antiviral factors OAS1 and ISG15. This study expands the pharmacological application scope of bufalin, and thereby establishes a novel strategic direction for developing plant-derived bufalin and its derivatives as anti‑herpesvirus agents.
Microplastic residues originating from lithium-ion battery components, including hydrophobic binder-derived poly(vinylidene fluoride) (PVDF) and separator-derived polyethylene (PE), are increasingly encountered in hydrometallurgical recycling streams, yet their impact on downstream lithium recovery remains largely unexplored. This study systematically investigates their influence on the reactive crystallization of lithium carbonate (Li2CO3) from aqueous lithium sulfate (Li2SO4) solutions. Precipitation at 80 °C was conducted at controlled polymer loadings (0.01-1.0 wt%), and crystallization kinetics, particle size distribution, filtration behavior, yield, and crystal morphology were evaluated using in situ monitoring, laser diffraction, and microscopy. PVDF markedly modified crystallization behavior, slightly reducing the turbidity onset times and promoting the formation of significantly finer particles, which led to a pronounced deterioration in filtration performance at higher loadings. Microscopy revealed that Li2CO3 crystallites preferentially nucleated and grew on PVDF surfaces, forming dense agglomerated structures rather than the larger, well-defined individual crystals observed in polymer-free systems. In contrast, PE exhibited similar but substantially weaker effects, with no clear evidence of surface-mediated nucleation. Despite these pronounced changes in crystal size, morphology, and separation behavior, the final Li2CO3 yield remained within 68-80% across all systems, with only a modest non-monotonic dependence on polymer loading. These findings demonstrate that hydrophobic polymer microplastics can act as effective heterogeneous nucleation sites, fundamentally altering crystallization pathways and downstream solid-liquid separation without significantly affecting equilibrium yield. The results highlight an overlooked process-level impact of microplastic contaminants and underscore the necessity of accounting for such impurities in the design and optimization of lithium-ion battery recycling flowsheets.
Diagnostic reference levels (DRLs) have been proven to be a useful tool for optimizing patient radiation exposure. National DRLs (NDRLs) are defined based on data from a representative sample of the healthcare facilities in a particular country. This project presents the survey to update the NDRLs for cardiac interventional procedures in Switzerland. Healthcare facilities performing cardiac procedures in Switzerland were asked to provide radiation dose data for adult cardiac interventional procedures performed over the course of one year. The dataset included the procedure name and the corresponding air kerma area product, air kerma at the reference point, fluoroscopy time and number of cine acquisitions. Thirty-five healthcare facilities (95% of the total) provided data. The procedures were grouped into 11 electrophysiology procedures, 4 cardiac catheterization procedures, and 3 structural heart procedures. For each healthcare facility and radiation quantity, the median values were calculated. Updated NDRLs were determined as the 75th percentile of the distribution of these median values. For example, the updated NDRL for air kerma area product was set at 24 Gy∙cm2 for coronary angiography and at 2 Gy∙cm2 for pacemaker implantation, reflecting a substantial reduction from the prior NDRL values of 50 and 30 Gy∙cm2, respectively. These new NDRL values are substantially lower than the previous ones, highlighting the importance of conducting regular updates to accommodate continuous patient dose optimization of and technological advancements.
Women of reproductive age represent a significant proportion of metabolic bariatric surgery (MBS) patients. However, research on their knowledge and perspectives regarding fertility and pregnancy post-MBS is scarce. A questionnaire was developed to comprehensively capture women's perspectives on pregnancy after MBS. To ensure content validity, the survey was assessed by health care experts using content validity indices and through semi-structured patient interviews. The cross-sectional survey was then distributed via social media platforms. Responses from women aged 18-45, with a history of MBS were included for analysis. A 49-item questionnaire was developed and content validated. A total of 90 individuals completed the survey and met the inclusion criteria. The mean age was 30.8 ± 5.1 years. Seventy-five (83.3%) had undergone Roux-en-Y gastric bypass surgery. Regarding optimal timing and sequencing of MBS and conception, 24 respondents (26.7%) believed that women wishing to become pregnant should do so prior to undergoing MBS, while 40 (44.5%) did not share this view. In terms of risk-benefit perception, 40 respondents (44.4%) expressed concern about maternal health and 34 (37.8%) indicated concern about the potential impact on infant health following MBS. These findings highlight variability in perceptions regarding optimal timing of pregnancy relative to MBS, with a notable proportion of respondents expressing concerns about maternal and infant health. This underscores the need for evidence-based guidance for women of reproductive age considering MBS.
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In this study, we optimized cryopreservation and hypothermic storage protocols for the European eel (Anguilla anguilla) spermatogonial stem cells (SSCs). As the European eel is listed as a critically endangered fish species on the IUCN red list, there is a strong need to develop and advance ex situ conservation strategies beyond the current conservation measures. Cryopreservation of SSCs was done through freezing and vitrification of testicular tissue pieces. Freezing was optimized through five sequential experiments and has yielded SSC post-thaw viability above 50%. The physiological competence of frozen/thawed cells was tested by transplanting donor-derived testicular cells into sterilized common carp larvae. After two months, gonads of 32% of the recipients displayed a positive fluorescent signal indicating that frozen/thawed cells retained physiological competence. Needle-immersed vitrification was optimized by testing different equilibration and vitrification solutions. SSCs displayed viability rates above 70% after protocol optimization. Hypothermic storage experiments displayed that storage of isolated testicular cells is more favorable than storing testicular tissue pieces, and that there was no significant reduction of SSC viability for 6 days when storing them in testicular cell suspension. Results obtained in this study are the first validated protocols for SSC preservation in the European eel and present the foundation for biobanking and future development of surrogate-based ex situ conservation programs for this and phylogenetically-related eel species.
The glucocerebrosidase (GBA) gene is the second most significant genetic risk factor for Parkinson's disease (PD) pathogenesis. Notably, GBA mutations not only enhance PD susceptibility in the general population but also accelerate disease progression. Nevertheless, the precise molecular mechanisms underlying GBA-associated PD pathogenesis remain elusive. In this study, we demonstrated that the L444P mutation in GBA significantly impairs the enzymatic activity of its encoded protein, glucocerebrosidase (GCase). It caused lysosomal dysfunction and increased α-synuclein (α-syn) expression and aggregation induced by α-syn preformed fibril (PFF). Mechanistically, our data revealed that the L444P GBA mutation increased reactive oxygen species (ROS) levels associated with activation of the p38 MAPK signaling pathway. Importantly, pharmacological inhibition of p38 MAPK pathway can change consistent with altered autophagic degradation and reduce PFF-induced α-syn aggregation, which is exacerbated by the L444P GBA mutation. These findings suggest that inhibiting p38 signaling provides a mechanistic rationale for targeting this pathway in GBA-associated PD.
To evaluate whether 3.0 T Multivoxel Proton Magnetic Resonance Spectroscopy (1H-MRS) can reliably and safely rule out malignancy in enhancing breast lesions with a size of at least 8 mm. Reducing the number of false positive (FP) MRI findings is essential to avoid unnecessary biopsies of benign lesions. This prospective study evaluated a consecutive series of 49 enhancing breast lesions ≥ 8 mm using multivoxel 1H-MRS (included 2017-2022). Each lesion's highest choline concentration was calculated and compared across histopathological subtypes. Stratified analysis was performed based on lesion size (<1 versus ≥ 1 cm). Highest choline concentration > 1.70 mmol/L was considered indicative of malignancy. ROC curves, sensitivity, specificity, negative predictive values (NPV), FP and false negative (FN) values were calculated. Out of 49 lesions (in women with a mean age of 41, range 23-71), 17 were malignant. The median highest choline (mmol/L, ± IQR, range) was significantly higher in malignant lesions [1.73(±1.14, 0.11-8.24)] compared to benign lesions [0.87 (±0.84, 0.09-6.37)(p = 0.02)]. ROC curve showed an AUC of 0.70(95%-CI 0.54-0.87). Using a cut-off value of 1.70 mmol/L sensitivity was 59%, specificity 91% specificity, and NPV 81% across all lesions. In lesions ≥ 1 cm (n = 37) only 3 FN and 2 FP cases were found, with a 70% sensitivity, 93% specificity and NPV of 89%. MRS could prevent target ultrasound (n = 9) or ultrasound plus biopsy (n = 6) in benign enhancing breast lesions ≥ 1 cm. 3.0 T 1H-MRS shows promising diagnostic performance in differentiating malignant from benign BI-RADS 3-5 breast lesions ≥ 1 cm. In smaller breast lesions the performance of MRS seems insufficient.
Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide. Although substantial advances in chemotherapy, molecular targeted therapy, and immunotherapy have improved clinical outcomes in select patient populations, therapeutic resistance remains the major obstacle to durable disease control. Accumulating evidence suggests that drug resistance in CRC does not result from isolated molecular events, but rather reflects a dynamic and adaptive process driven by coordinated tumor intrinsic programs, as well as continuous interactions between tumor cells and their surrounding microenvironment. In this Review, we present a systematic overview of the clinical manifestations and biological foundations of resistance to cytotoxic chemotherapy, targeted therapy, and immune checkpoint blockade in CRC. We summarize tumor intrinsic resistance mechanisms, including oncogenic signaling reprogramming, DNA damage response modulation, metabolic and redox adaptation, ubiquitin-regulated proteostasis, epigenetic and RNA-mediated regulation, evasion of programmed cell death, and the emergence of cancer stem cell and drug-tolerant persister states. In parallel, we examine the contribution of the tumor microenvironment, including cancer-associated fibroblasts, immunosuppressive immune networks, extracellular vesicle-mediated communication, and the gut microbiota, in establishing protective niches that promote resistance and limit therapeutic efficacy. We further discuss how emerging approaches such as single-cell and spatial multi-omics profiling, liquid biopsy, and longitudinal molecular monitoring have reshaped the understanding of drug resistance as a continuous evolutionary process under therapeutic selection pressure. Finally, we highlight therapeutic strategies inspired by systems biology and evolutionary principles, with an emphasis on rational combination and sequencing regimens, targeting adaptive vulnerabilities, and remodeling the tumor ecosystem to enable more durable and precise control of CRC.
High-dose vitamin C (HDVC) has a short half‑life of approximately 2 h, and once‑daily dosing results in sub‑therapeutic plasma concentrations for most of the dosing interval, potentially limiting its pro‑oxidant antitumor activity. In this phase I study, 18 patients with advanced solid tumors were assigned to three cohorts (n = 6 each): Group A (0.5 g/kg once daily, total daily dose 0.5 g/kg), Group B (0.5 g/kg every 12 h, total daily dose 1.0 g/kg), and Group C (0.75 g/kg every 12 h, total daily dose 1.5 g/kg). Plasma trough concentrations were measured daily for 7 days. Compared to Group A, Group B exhibited significantly higher trough concentrations throughout the study (P < 0.05), demonstrating superior maintenance of therapeutic levels. Further dose escalation to 0.75 g/kg twice daily (Group C) provided no additional trough concentration benefit versus Group B (P > 0.05), consistent with the plateau in peak concentrations at single doses above approximately 70 g/m² (∼1.0 g/kg). All regimens were well tolerated, with only one mild nausea (5.6%) and no serious adverse events. Fractionated dosing (0.5 g/kg every 12 h) significantly improves trough concentration maintenance with good tolerability. This optimized regimen (total daily dose 1.0 g/kg) provides a rational pharmacokinetic basis for future phase II trials designed to evaluate whether sustained pro‑oxidant levels translate into enhanced clinical efficacy.
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Cancer and its treatment-related effects may impair fertility and increase reproductive concerns (RCs) among adolescent and young adult (AYA) survivors at their peak reproductive years. To assess RCs in survivors and examine their associated factors and pathways. A cross-sectional study was conducted with 209 AYA cancer survivors aged 15-39 years from June 2023 to December 2024. Participants' RCs, cancer-related sexual and reproductive health knowledge, attitudes, and needs were measured. Multiple linear regression and structural equation modeling were performed. Participants' mean RCs score was 70.17 ± 6.70. Regression showed that cancer-related sexual and reproductive health attitudes (B = 0.646, p < 0.001), needs (B = 0.516, p = 0.001) were positively associated with RCs. Awareness of fertility preservation options, including sperm donation (B = 2.034, p = 0.005) and testicular replacement (B = 2.224, p = 0.044), was also positively associated with RCs. Conversely, endorsement of artificial uterus technology (B = -3.032, p = 0.007), perceived impact of habitual sleep deprivation on fertility (B = -1.491, p = 0.030), and a history of hematologic malignancy (B = -6.256, p = 0.003) were negatively associated with RCs. Structural equation modeling showed that attitudes (β = 0.531, p < 0.001), knowledge (β = 0.201, p = 0.003), and needs (β = 0.295, p = 0.006) were significantly associated with RCs. RCs among AYA cancer survivors are associated with sexual and reproductive health-related attitudes, knowledge, needs. Integrated education and supportive care may be relevant for addressing RCs in this population.
Antimicrobial resistance (AMR) is a major global health threat, largely driven by inappropriate and excessive antibiotic use. Italy has historically reported antibiotic consumption rates above the European average, especially in primary care. In 2017, Italy implemented the National Action Plan on Antimicrobial Resistance (NAP-AMR), including targets for reducing overall community antibiotic and fluoroquinolone use. This study evaluated the impact of NAP-AMR on antibiotic consumption trends in Italian primary care from 1999 to 2024. Quasi-experimental interrupted time series study. Annual ECDC data were expressed as defined daily doses (DDD) per 1000 inhabitants per day. Total antibiotic consumption was analyzed for 1999-2024 and fluoroquinolone consumption for 2005-2024. Segmented linear regression with Newey-West standard errors estimated post-2017 changes in level and trend. Total systemic antibiotic consumption was the primary outcome, and fluoroquinolone consumption was the secondary outcome. Total antibiotic consumption showed a significant pre-intervention upward trend, increasing annually by 0.10 DDD per 1000 inhabitants per day (annual change = 0.096; p = 0.032; 95% CI: 0.014 to 0.178). NAP-AMR implementation was associated with a significant immediate reduction in total antibiotic use (mean level difference = -4.940; p = 0.003; 95% CI: -7.864 to -2.016), while the post-intervention slope change was not significant (annual change = 0.126; p = 0.606; 95% CI: -0.346 to 0.599). Fluoroquinolone consumption showed a significant pre-intervention upward trend (annual change = 0.039; p = 0.016; 95% CI: 0.011 to 0.066) and a significant immediate reduction (mean level difference = -1.079; p = 0.023; 95% CI: -1.910 to -0.248). The post-intervention trend was negative but not significant (annual change = -0.219; p = 0.096; 95% CI: -0.459 to 0.021). NAP-AMR was associated with immediate reductions in total antibiotic and fluoroquinolone consumption, but sustained trend changes were not statistically significant. No significant long-term trend change was observed, underscoring ongoing surveillance and future evaluation.
Glioblastoma represents the most aggressive primary brain malignancy, with median survival of only 14-16 months despite standard therapy. Immune checkpoint inhibitors show limited efficacy due to the immunologically "cold" tumor microenvironment. To develop and evaluate an engineered oncolytic vaccinia virus co-expressing a PD-L1 inhibitor and GM-CSF (VV-iPDL1/GM), and assess its synergy with systemic anti-PD-1 therapy. VV-iPDL1/GM was engineered to express a soluble PD-1 extracellular domain-IgG-Fc fusion protein and GM-CSF. Immunomodulatory effects were assessed using glioblastoma-T cell co-cultures. Antitumor efficacy was evaluated in orthotopic GL261 glioblastoma models. VV-iPDL1/GM demonstrated potent PD-L1 inhibition (IC₅₀ = 145 ± 23 nM) and enhanced CD8+ T cell activation while reducing regulatory T cells. In vivo, VV-iPDL1/GM monotherapy achieved 94.5% tumor growth inhibition, doubled median survival (47.5 vs. 22.5 days), and resulted in 30% long-term survivors. Combination with systemic anti-PD-1 therapy further improved tumor inhibition to 99.7%, extended median survival to 71.5 days (3.2-fold increase), and achieved 60% long-term survival. Treatment produced 4.8-fold increased CD8+ T cell infiltration and favorable CD8/Treg ratios (19.8:1 vs. 1.7:1). Mechanistic analysis revealed synergistic interactions with Hill coefficients of 1.8-2.3. VV-iPDL1/GM effectively remodels the glioblastoma immune microenvironment through integrated oncolysis, immune activation, and checkpoint inhibition. Localized delivery circumvents blood-brain barrier limitations while minimizing systemic toxicity, highlighting its clinical translation potential.
To evaluate the association between selective intraoperative multi-vessel embolization (SiM-VE) and perioperative transfusion during cesarean hysterectomy for histologically confirmed placenta accreta spectrum (PAS). This retrospective cohort study (2012-2024) included patients undergoing cesarean hysterectomy for histologically confirmed PAS, comparing SiM-VE with surgical devascularization alone. All SiM-VE patients underwent bilateral uterine artery embolization, with additional selective embolization of collateral/neovascular supply performed in the majority. The primary outcome was perioperative packed red blood cell transfusion. Doubly robust inverse probability of treatment weighting mitigated confounding by indication, and Oaxaca-Blinder decomposition partitioned the difference in operative duration. Of 268 patients (SiM-VE n = 234; No SiM-VE n = 34), the SiM-VE group had higher anterior previa (161 [68.8%] vs 14 [41.2%]; P = 0.003), percreta (109 [46.6%] vs 7 [20.6%]; P = 0.005), and lower preoperative hemoglobin (10.9 ± 1.2 vs 11.4 ± 1.7 g/dL; P = 0.03). In the primary doubly robust model, SiM-VE was associated with lower odds of perioperative transfusion (adjusted odds ratio 0.25; 95% CI, 0.11-0.56; P = 0.001). Operative duration was longer in the SiM-VE group (315.0 ± 66.8 vs 180.2 ± 55.2 min; P < 0.001), with decomposition attributing approximately 30% of the difference to baseline complexity. Access-site arterial thrombosis requiring surgical intervention occurred in 3 (1.3%) patients. SiM-VE was associated with lower adjusted odds of perioperative transfusion in this single-center cohort, representing a trade-off between lower allogeneic blood exposure and longer operative duration alongside a 1.3% risk of access-site arterial thrombosis.
This review evaluates the effects of wearable device-telemonitored Baduanjin on exercise tolerance and cardiac function in patients with chronic heart failure (CHF). A comprehensive literature search was performed in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database and Chinese Biomedical Literature Database (CBM) from their inception to 1 January 2026. The search aimed to identify randomised controlled trials investigating Baduanjin for CHF that explicitly used wearable devices. Study screening, data extraction and Cochrane RoB 2.0 bias assessment were performed independently by two reviewers with discrepancies were resolved by a third. Given significant clinical heterogeneity across the included studies, a narrative synthesis of the findings was conducted, supported by tabulated presentation of outcome data. Three randomized controlled trials involving 248 participants were included. Individual studies reported that wearable device-telemonitored Baduanjin was associated with improvements in several clinical outcomes in patients with CHF. Reported benefits included increased 6-minute walking distance (568.58 m vs. 367.47 m, P < 0.05), higher peak oxygen uptake (19.00 vs. 17.00 ml/[kg·min], P < 0.001) and improved left ventricular ejection fraction (52.60% vs. 45.28% and 42.79%, P < 0.05). Improvements were also observed in quality of life, depression symptoms, cardiovascular readmission in the intervention group of individual studies. No exercise-related adverse events were reported. Current evidence suggests that wearable device-telemonitored Baduanjin may potentially improve key outcomes in patients with chronic heart failure, However, these findings are based on a narrative synthesis of individual studies and should therefore be interpreted cautiously. Further high-quality, standardised randomised controlled trials are urgently needed.